AIR Personal Information Form

CONTACT DETAILS

* Your given name

* Your family name

* Contact number

* Email

Are you part of a group coming into residence?

If yes, please tell us the name of the group or your coordinators name

* What is your arrival date?

Arrival times are between 2pm & 4pm only. As we are located in a rural area, a staff member will meet you at Bundanon to induct you on to the site.

* Proposed arrival time?

* What is your departure date?

Departure times are ideally before 10am

* Which spaces are you booked into?

Press CTRL + click (CMD + click on Mac) to select multiple options.

EMERGENCY CONTACT

* Who should we contact in an emergency?

* What is their relationship to you?

What is their mobile phone number?

What is their landline phone number?

* What is their email?

MEDICAL INFORMATION

The following information will help us in an emergency. It is however totally your choice whether you want to share this with us.

Do you have any allergies?

If yes, please give details

Do you take any medication?

If yes, please give details

Do you have any existing medical conditions that we should know about?

If yes, please give details

Do you have a doctor we should contact in an emergency?

If yes, please give the doctor's name and contact number?